We have previously demonstrated the role of high-resolution ultrasonography (US) in preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism (PHPT) and no thyroid abnormalities. The present study prospectively evaluated the possible additional value of 99mTc-sestamibi (MIBI) in patients with PHPT and concomitant multinodular thyroid disease (MND). Patients with PHPT underwent US and MIBI scintigraphy prior to neck exploration. Imaging data were correlated with the site and pathology of the parathyroid tissue removed and were analyzed separately for patients with MND and those with a normal thyroid gland. Among 77 patients with a solitary parathyroid adenoma at surgery, 40 had concomitant MND, whereas 37 patients had no morphologic changes in the thyroid gland, on US or at surgery. Prior to surgery, MIBI scintigraphy depicted 58 of the 77 adenomas (75%) and US localized 51 (66%): the combined sensitivity was 87% (67/77). Among the 37 patients with no thyroid nodules, MIBI located 29 (78%) and US identified 30 (81%) of the adenomas; the combined sensitivity was 89%. In the 40 patients with MND, MIBI identified 29 adenomas (73%) and US localized only 53% (21/40); the combined sensitivity was 85%. Overall, the positive predictive value (PPV) of MIBI for detecting a solitary parathyroid adenoma was 94%, for US it was 88%, and with the two tests combined it was 97%. In patients with no thyroid abnormalities, the PPV of MIBI and US was 97%, but it decreased to 91% and 78%, respectively, in patients with MND. Two patients with false-positive findings on both MIBI and US had associated thyroid disease. Hence MIBI scintigraphy contributes to localization of a solitary parathyroid adenoma mainly in patients with concomitant MND. The combined MIBI and US modalities result in sparing these patients bilateral neck exploration.
Imaging-guided small-bore cutting-edge needle biopsy of splenic lesions is a safe procedure. In most patients with primary or recurrent lymphoma, the disease subtype can be diagnosed reliably.
Horseshoe kidney is a difficult sonographic diagnosis, especially if the isthmus is not seen. The purposes of this report are to review the sonographic images in 34 patients with proven horseshoe kidney, to discuss the limitations of ultrasonography in demonstrating the anomaly, and to identify features that would alert the examiner to the possibility of a horseshoe kidney. Among 34 patients, the isthmus was noted in 27. Of the 67 kidneys studied, 52 (78%) were judged to be low‐lying, and in 24 (36%) the sonographic images suggested malrotation with anteriorly pointing pelvis. Additional sonographic features seen in the 67 kidneys included a bent or curved configuration of the kidney in the long axis (58%), tapering and elongation of the lower pole (60%), and a poorly defined inferior border of the kidney (84%). These features should suggest the presence of a horseshoe kidney and direct the examiner to search for the isthmus.
This report presents a gamut of ultrasound signs that may be seen in emphysematous cholecystitis. These can be summarized as follows: Intraluminal gas: (a) A dense band of hyper-reflective echoes with distal reverberations when gallbladder is full of gas. (b) A band of reverberations in the gas-filled portion of the gallbladder with the usual signs of cholecystitis in the bile-filled portion when the gallbladder is partially full of gas. Intramural gas: (c) An area of high reflectivity in the gallbladder wall with reverberations that may change position with change in position of patient. (d) A bright hyper-reflective ring emanating from the whole circumference of the gallbladder.
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